ECE2015 Eposter Presentations Pituitary: basic and neuroendocrinology (62 abstracts)
Inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome: experience of a Tertiary Portuguese Hospital
Ana Coelho Gomes 1 , Lia Lucas Neto 2 , Maria Raquel Carvalho 1 , Eduardo Barreiros 1 , José Maria Aragüés 1 , Luís Barreiros 1 , Jorge Campos 2 & Mário Rui Mascarenhas 1
1Endocrinology, Diabetes and Metabolism Department, Santa Maria Hospital, Lisbon, Portugal; 2Neuroradiology Department, Santa Maria Hospital, Lisbon, Portugal.
Introduction: Cushing’s disease (CD) is responsible for 80% of endogenous Cushing’s syndrome (CS). However, distinguishing the cause of ACTH-dependent CS – CD vs ectopic CS – can be extremely difficult. Bilateral inferior petrosal sinus sampling (IPSS) has the highest diagnostic accuracy in this evaluation.
Objectives: The aims of this study were to determine the accuracy of bilateral IPSS in the differential diagnosis of ACTH-dependent CS and in predicting adenoma lateralisation in CD.
Design: We retrospectively analysed the ACTH levels in inferior petrosal sinus and peripheral blood samples of eleven consecutive patients with ACTH-dependent CS that performed bilateral IPSS between 2005 and 2014 in Santa Maria Hospital in Lisbon. ACTH levels from both inferior petrosal sinus and peripheral blood were measured before and after corticotropin-releasing hormone (CRH) administration – 0′, 5′, 10′, and 15′. Ratios of central-to-peripheral and interpetrosal ACTH levels were calculated.
Results: IPSS was uneventfully performed in the eleven patients and it was suggestive of CD in nine patients, ectopic CS in one patient and inconclusive in another one. Concerning the nine patients with CD, the basal IPSS central-to-peripheral ACTH ratios were diagnostic for CD (>2) in eight patients (88.9%) and the post-CRH IPSS central-to-peripheral ACTH ratios were diagnostic for CD (>3) in nine patients (100%). ACTH lateralization was found (interpetrosal ratios ≥1.4) in eight patients (88.9%). In the patient with ectopic ACTH CS, the IPSS pre- and post-CRH ACTH ratios were negative, as expected. Transsphenoidal surgery was performed in seven of the nine patients with CD and the histologic examination confirmed the diagnosis of ACTH-secreting pituitary adenoma in all of them. Two patients are waiting for surgery.
Conclusion: IPSS was a safe and well-tolerated procedure in our study group. It was effective in the differential diagnosis of ACTH-dependent CS and useful in planning CD surgical therapy.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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